scholarly journals The Influence of Deterioration of Kidney Function on the Diagnostic Power of Laboratory Parameters Used in the Prognostic Classification of AL Amyloidosis

2021 ◽  
Vol 10 (21) ◽  
pp. 4903
Author(s):  
Emilia Czyżewska ◽  
Olga Ciepiela
Keyword(s):  
Al Amyloidosis ◽  
Additional Parameter ◽  
Primary Amyloidosis ◽  
Entire Study ◽  
Laboratory Parameters ◽  
Heart Involvement ◽  
Myocardial Involvement ◽  
Diagnostic Power ◽  
The Impact

There is a possibility that renal dysfunction may potentially reduce the diagnostic power of the laboratory parameters Tn, NT-proBNP and sFLC levels, used in the current prognostic classification of AL amyloidosis and the diagnosis of heart involvement by amyloid. In this study, the impact of lowering the eGFR value on the usefulness of these parameters in the prognosis and diagnosis of the presence of amyloid in the myocardium was assessed in a group of 71 patients with newly diagnosed primary amyloidosis. The assessment of diagnostic power of laboratory parameters was performed on the entire study group, and in the ranges of eGFR ≥ 60 and < 60 mL/min/1.73 m2. It has been proven that, with a decrease in the eGFR value, the concentrations of NT-proBNP and the κ uninvolved light chains increase significantly (p < 0.001). To assess the diagnostic power of laboratory parameters used in the diagnosis of myocardial involvement in patients with AL amyloidosis, an ROC analysis was performed. The highest values of AUC were obtained for the NT-proBNP concentration (AUC = 0.906). The lowest values of the AUC and Youden’s index were obtained for the dFLC values (AUC = 0.723), and involved κ FLC concentration (AUC = 0.613). For all compared parameters, the smallest values of the AUC were obtained for eGFR (<60 mL/min/1.73 m2). It seems that the most suitable cardiac parameter used in the prognostic classification of AL amyloidosis, independent of renal function, is TnI. It should be noted that a concentration of involved λ chains hada higher diagnostic power to assess the heart involvement, compared to the routinely used “cardiac parameters”, TnI and NT-proBNP. It can therefore be an additional parameter used to assess the presence of amyloid in the myocardium. A decrease in eGFR value influenced the change in the diagnostic cut-off points of the most analyzed laboratory parameters. Finally, it is concluded that lowering the eGFR value reduces the utility of laboratory parameters used in the prognostic classification of AL amyloidosis.

High-Sensitivity Troponin Assay Improves the Detection of Cardiac Involvement in AL Amyloidosis and Is the Most Powerful Prognostic Determinant.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1782-1782
Author(s):  
Giovanni Palladini ◽  
Alessandra Barassi ◽  
Gabriele Sarais ◽  
Ruggero Capra ◽  
Andrea Foli ◽  
...  
Keyword(s):  
Cardiac Involvement ◽  
Conflicts Of Interest ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Response To Therapy ◽  
Al Amyloidosis ◽  
Cardiac Damage ◽  
Hematologic Response ◽  
Heart Involvement ◽  
The Impact

Abstract Abstract 1782 Poster Board I-808 The heart is involved in approximately two thirds of patients with AL amyloidosis and the prognosis of the disease is largely dependent on the severity of cardiac damage. Heart dysfunction can be assessed by measuring the serum concentrations of N terminal natriuretic peptide type B (NT-proBNP) and of cardiac troponins (cTn). The combination of these biomarkers allows an accurate prognostic stratification of patients with AL amyloidosis. Recently, new generation of more sensitive assays for cTn, characterized by low limits of detection and low imprecision, have been developed, aiming at identifying minimal cardiac damage. We report the impact of a highly sensitive (hs) cTnT assay on detection of heart involvement, prognosis and response to therapy in 109 consecutive newly diagnosed patients with AL amyloidosis. The hs-cTnT was measured on the Modular E instrument with a precommercial immunoassay from Roche Diagnostics on frozen sera collected at the time of diagnosis and stored at -80°C. The 99th centile of hs-cTnT concentration in sera from 546 healthy volunteers is 14 ng/L (95%CI 12.4-24.9 ng/L). NT-proBNP and cTnI were measured with commercially available assays. The upper reference limit of NT-proBNP is 332 ng/L and for cTnI is 40 ng/L. Heart involvement was defined according to the International Society of Amyloidosis consensus criteria as a mean left ventricular wall thickness (mLVW) >12 mm in the absence of other causes. Sixty-nine of the 109 patients (63%) fulfilled the echocardiographic criteria of heart involvement. Among these patients, 74% had elevated cTnI, 96% had high hs-cTnT and 100% had elevated NT-proBNP. Fifteen patients who did not have echocardiographic heart involvement at presentation reached a mLVW >12 mm within 6 months from diagnosis. Among them, cTnI was elevated at presentation in 33% of cases, hs-cTnT in 80% (p=0.01 compared to cTnI) and NT-proBNP in 73%, indicating that hs-cTnT and NT-proBNP can detect amyloid cardiac involvement when it is still unapparent by conventional echocardiographic criteria. Thirty-seven (34%) patients died and the median follow-up of living patients was 38 months (range 14-67 months). Survival was reduced in patients with hs-cTnT >14 ng/L (58% vs. 84% surviving at 3 years, p=0.01) and NT-proBNP >332 ng/L (58% vs. 86% surviving at 3 years, p=0.02) and cTnI >40 ng/L (52% vs. 75% surviving at 3 years, p=0.007). At multivariate analysis ln(hs-cTnT) was the only variable significantly associated with survival (HR 1.576, 95%CI 1.048-2.371, p=0.03). All the patients were treated with melphalan-dexamethasone and 66 (60%) reached hematologic response. The hs-cTnT cutoff best predicting survival after treatment was 68 ng/L (45% vs. 80% surviving at 3 years, p=0.0003). This cutoff, in combination with hematologic response to therapy, could differentiate the patient population into 3 groups with significantly different survival. Estimated survival at 3 years was 30% in non responders with hs-cTnT >68 ng/L, 51% in those who obtained either hematologic response or had hs-cTnT <68 ng/L (p=0.05) and 95% in responders with hs-cTnT <68 ng/L (p<0.0001). Cardiac troponin measured with a high-sensitivity assay significantly improved the sensitivity, compared with commercially available troponin assay, for cardiac damage caused by AL amyloidosis and represents now the most powerful prognostic determinant. Patients who obtain hematologic response and a hs-cTnT concentration below the threshold of 68 ng/L enjoy prolonged survival. Disclosures No relevant conflicts of interest to declare.

The Impact of Internal Work Environment on the Retention of Healthcare Providers at Turaif General Hospital

2019 ◽  
Vol 10 (12) ◽  
pp. 1183-1199
Author(s):  
Mohammed Alrouili ◽  
Keyword(s):  
Work Environment ◽  
General Hospital ◽  
Professional Growth ◽  
Healthcare Providers ◽  
Entire Study ◽  
Internal Work ◽  
Research Findings ◽  
Study Population ◽  
The Right ◽  
The Impact

This study attempted to identify the impact of internal work environment on the retention of healthcare providers at Turaif General Hospital in the Kingdom of Saudi Arabia. In particular, the study aimed to identify the dimensions of work circumstances, compensation, and relationship with colleagues, professional growth, and the level of healthcare providers’ retention. In order to achieve the study goals, the researcher used the descriptive analytical approach. The researcher used the questionnaire as the study tool. The study population comprised all the healthcare providers at Turaif General Hospital. Questionnaires were distributed to the entire study sample that consisted of 220 individuals. The number of questionnaires valid for study was 183 questionnaires. The research findings were as follows: the participants’ estimate of the work circumstances dimension was high (3.64), the participants’ estimate of the compensation dimension was moderate (3.32), the participants’ estimate of the relationship with colleagues dimension was high (3.62), the participants’ estimate of the professional growth dimension was weak (2.39), and the participants’ estimate of healthcare providers’ retention level was intermediate (2.75). Accordingly, the researcher’s major recommendations are: the need to create the right atmosphere for personnel in hospitals, the interest of the hospital to provide the appropriate conditions for the staff in terms of the physical and moral aspects for building the work adjustment in the staff, and conducting training courses and educational lectures for personnel in hospitals on how to cope with the work pressures.

ON THE CLASSIFICATION OF DIGITAL TECHNOLOGIES IN CIVIL PROCESS

2019 ◽  
pp. 27-35
Author(s):  
Alexandr Neznamov
Keyword(s):  
Information Processing ◽  
Scientific Community ◽  
Digital Technologies ◽  
Significant Feature ◽  
Legal Proceedings ◽  
Civil Process ◽  
Civil Proceedings ◽  
Processing Information ◽  
The Impact

Digital technologies are no longer the future but are the present of civil proceedings. That is why any research in this direction seems to be relevant. At the same time, some of the fundamental problems remain unattended by the scientific community. One of these problems is the problem of classification of digital technologies in civil proceedings. On the basis of instrumental and genetic approaches to the understanding of digital technologies, it is concluded that their most significant feature is the ability to mediate the interaction of participants in legal proceedings with information; their differentiating feature is the function performed by a particular technology in the interaction with information. On this basis, it is proposed to distinguish the following groups of digital technologies in civil proceedings: a) technologies of recording, storing and displaying (reproducing) information, b) technologies of transferring information, c) technologies of processing information. A brief description is given to each of the groups. Presented classification could serve as a basis for a more systematic discussion of the impact of digital technologies on the essence of civil proceedings. Particularly, it is pointed out that issues of recording, storing, reproducing and transferring information are traditionally more «technological» for civil process, while issues of information processing are more conceptual.

Influence of internal and external risks on sustainability of financial system of Аltai krai

2018 ◽  
Vol 35 (4) ◽  
pp. 133-136
Author(s):  
R. N. Ibragimov
Keyword(s):  
Sustainable Development ◽  
Financial Stability ◽  
Management Strategy ◽  
Financial System ◽  
Risk Management Strategy ◽  
The Sustainable Development ◽  
The Stability ◽  
The Impact

The article examines the impact of internal and external risks on the stability of the financial system of the Altai Territory. Classification of internal and external risks of decline, affecting the sustainable development of the financial system, is presented. A risk management strategy is proposed that will allow monitoring of risks, thereby these measures will help reduce the loss of financial stability and ensure the long-term development of the economy of the region.

Fish diversity

2017 ◽  
Author(s):  
Derek Burton ◽  
Margaret Burton
Keyword(s):  
Life Style ◽  
Fish Diversity ◽  
Additional Species ◽  
The Impact ◽  
Current Species

Fish diversity is considered in terms of variety of their morphological, taxonomic, habitat and population attributes. Fish, with over 30, 000 current species, represent the largest group of vertebrates. The complexity of classification of a group of this size and antiquity, together with recognition of additional species, demands continuous ongoing revision. The impact of the recent fundamental changes in fish classification in 2016 is discussed. Life in water involves adaptations to widely different habitats which can result in physiological morphological and life-style variations which are reviewed.

scholarly journals The halo model as a versatile tool to predict intrinsic alignments

2020 ◽  
Author(s):  
Maria Cristina Fortuna ◽  
Henk Hoekstra ◽  
Benjamin Joachimi ◽  
Harry Johnston ◽  
Nora Elisa Chisari ◽  
...  
Keyword(s):  
Degrees Of Freedom ◽  
Power Spectra ◽  
Stage Iv ◽  
Stage Iii ◽  
Radial Dependence ◽  
Additional Parameter ◽  
Small Scales ◽  
Cosmic Shear ◽  
Galaxy Populations ◽  
The Impact

Abstract Intrinsic alignments (IAs) of galaxies are an important contaminant for cosmic shear studies, but the modelling is complicated by the dependence of the signal on the source galaxy sample. In this paper, we use the halo model formalism to capture this diversity and examine its implications for Stage-III and Stage-IV cosmic shear surveys. We account for the different IA signatures at large and small scales, as well for the different contributions from central/satellite and red/blue galaxies, and we use realistic mocks to account for the characteristics of the galaxy populations as a function of redshift. We inform our model using the most recent observational findings: we include a luminosity dependence at both large and small scales and a radial dependence of the signal within the halo. We predict the impact of the total IA signal on the lensing angular power spectra, including the current uncertainties from the IA best-fits to illustrate the range of possible impact on the lensing signal: the lack of constraints for fainter galaxies is the main source of uncertainty for our predictions of the IA signal. We investigate how well effective models with limited degrees of freedom can account for the complexity of the IA signal. Although these lead to negligible biases for Stage-III surveys, we find that, for Stage-IV surveys, it is essential to at least include an additional parameter to capture the redshift dependence.

scholarly journals Formation of an Export-Oriented Agricultural Economy and Regional Open Innovations

2021 ◽  
Vol 7 (1) ◽  
pp. 32
Author(s):  
Victor L. Shabanov ◽  
Marianna Ya Vasilchenko ◽  
Elena A. Derunova ◽  
Andrey P. Potapov
Keyword(s):  
Agricultural Economy ◽  
Institutional Management ◽  
Agricultural Exports ◽  
Modeling Methodology ◽  
Fixed Assets ◽  
Analysis Application ◽  
The Impact ◽  
The Relationship

The aim of the work is to find relevant indicators for assessing the relationship between investments in fixed assets in agriculture, gross output of the industry, and agricultural exports using tools for modeling the impact of innovation and investment development on increasing production and export potential in the context of the formation of an export-oriented agricultural economy. The modeling methodology and the proposed estimating and forecasting tools for diagnosing and monitoring the state of sectoral and regional innovative agricultural systems are used to analyze the relationship between investments in fixed assets in agriculture, gross output of the industry, and agricultural exports based on the construction of the classification of Russian regions by factors that aggregate these features to diagnose incongruence problems and to improve institutional management in regional innovative export-oriented agrosystems. Based on the results of the factor analysis application, an underestimated role of indicators of investment in agriculture, the intensity and efficiency of agricultural production, were established. Based on the results of the cluster analysis, the established five groups of regions were identified, with significant differences in the level of investment in agriculture, the volume of production of the main types of agricultural products, and the export and exported food. The research results are of practical value for use in improving institutional management when planning reforms and transformations of regional innovative agrosystems.

scholarly journals Minimization of the Line Resistance Impact on Memdiode-Based Simulations of Multilayer Perceptron Arrays Applied to Pattern Recognition

2021 ◽  
Vol 11 (1) ◽  
pp. 9
Author(s):  
Fernando Leonel Aguirre ◽  
Nicolás M. Gomez ◽  
Sebastián Matías Pazos ◽  
Félix Palumbo ◽  
Jordi Suñé ◽  
...  
Keyword(s):  
Pattern Recognition ◽  
Ex Situ ◽  
Multilayer Perceptrons ◽  
Spice Simulation ◽  
Large Dataset ◽  
High Line ◽  
Calibration Algorithm ◽  
The Impact ◽  
Line Resistance

In this paper, we extend the application of the Quasi-Static Memdiode model to the realistic SPICE simulation of memristor-based single (SLPs) and multilayer perceptrons (MLPs) intended for large dataset pattern recognition. By considering ex-situ training and the classification of the hand-written characters of the MNIST database, we evaluate the degradation of the inference accuracy due to the interconnection resistances for MLPs involving up to three hidden neural layers. Two approaches to reduce the impact of the line resistance are considered and implemented in our simulations, they are the inclusion of an iterative calibration algorithm and the partitioning of the synaptic layers into smaller blocks. The obtained results indicate that MLPs are more sensitive to the line resistance effect than SLPs and that partitioning is the most effective way to minimize the impact of high line resistance values.

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